Jindal’s Rx: the Most Coordinated System of Care that No One Can Access

Louisiana Gov. Bobby Jindal’s (R) proposed Medicaid reforms are getting a lot of press. Jindal proposes to expand eligibility for Medicaid, enroll Medicaid patients in private managed-care plans, and do other things to improve the quality of care. Writing in The American Spectator, Joseph Lawler says the approach is “market-based” and “could forestall universal health care.”

A friend asked my thoughts about Jindal’s proposal. Here’s what I emailed back:

Why is it that when politicians propose giving taxpayer dollars to private companies, people think that’s “market-based”?

Jindal’s plan is not market-based reform. As a general matter, market-based charity care is just that: private charity. So the only market-based Medicaid reforms are those that remove people from the Medicaid rolls — e.g., federal block grants, eligibility restrictions, etc.

Jindal wants to expand eligibility. For a welfare program. And we call that market-based?

Jindal may be able to improve the quality of care through greater coordination. Which looks good on paper. But if the quality of care in Medicaid improves, more people will enroll. Only 2/3 of those eligible actually sign up for the program. (Many of the 1/3 who don’t enroll actually have private coverage.) So improving Medicaid benefits could cause enrollment to increase 50 percent. And that’s before Jindal expands the eligibility rules.

With all the additional cost pressure, what’s going to happen to Medicaid payments and enrollees’ access to docs? (There are reasons why Medicaid pays so little.)

Louisiana’s Medicaid program could someday achieve the most coordinated system of care that no one can access. Should we pull people out of private health plans for that?

Expanding enrollment in a government-run health plan is supposed to forestall universal coverage? Discerning consumers of market-based ideas should keep shopping.

Don’t Let the Left Nationalize Health Insurance

With left-wing Democrats controlling Congress and the White House, and many special-interest groups clamoring for reform, people are starting to talk about comprehensive health care reform as if it were a done deal.

Yet comprehensive reform could easily crater — and it should crater if it includes any of the following:

  1. Government-run health care for the middle class
  2. Mandates
  3. Price controls

Those reforms would effectively nationalize health insurance, regardless of whether we continue to call it “private” insurance.

Republicans, moderate Democrats, and independents should kill any reforms that include any of those three items. Here’s why, and how.

Great Moments in Local Government

This story probably has a deeper meaning for those concerned about a hyper-sensitive society. It also probably raises the hackles of those trying to protect 2nd Amendment rights. But my immediate reaction was that only government could do something as stupid as arrest a 10-year old boy for having a toy cap gun:

The latest case of zero-tolerance at the public schools has a 10-year-old student sadder and wiser, and facing expulsion and long-term juvenile detention. And it has his mother worried that his punishment has already been harsher than the offense demands. “I think I shouldn’t have brought a gun to school in the first place,” said the student, Alandis Ford, sitting at home Thursday night with his mother, Tosha Ford, at his side. Alandis’ gun was a “cap gun,” a toy cowboy six-shooter that his mother bought for him. “We got it from Wal-Mart for $5.96,” Tosha Ford said, “in the toy section right next to the cowboy hats. That’s what he wanted because it was just like the ones he was studying for the Civil War” in his fifth-grade class at Fairview Elementary School. …Tosha said that Wednesday afternoon, after school, “six police officers actually rushed into the door” of their home. “He [Alandis] opened the door because they’re police. And then they just kind of pushed him out of the way, and asked him, ‘Well where’s the gun, where’s the real gun?’ And they called him a liar… they booked him, and they fingerprinted him.” …Alandis was charged with possessing a weapon on school property and with terroristic acts and threats. …Sherri Viniard, the Director of Public Relations for the Newton County School System, emailed a statement to 11Alive News Thursday that reads, in part: “Student safety is our primary concern, and although this was a toy gun, it is still a very serious offense and it is a violation of school rules. We will not tolerate weapons of any kind on school property.” Alandis had his first hearing in juvenile court on Thursday. Tosha said the case worker assigned to Alandis will recommend a period of probation, rather than juvenile detention. The judge will make the final decision. Tosha said Alandis is not allowed back in school for now. She has a meeting scheduled with school administrators. She does not know if he will be expelled, and is hoping for no more than a ten-day suspension.

‘Tis Better to Take

In a sign of how toweringly stacked government is against he who believes ‘tis wrong to steal, my place of residence offers taxpayer-subsidized classes on how to maximize your taxpayer subsidy for college. That’s right: The government subsidizes classes on subsidy-grubbing.

“Strategies are revealed on how to reposition assets to minimize the amount the government determines you can afford to pay,” proudly declares the description of “Paying for College without Going Broke” in the winter 2009 adult education catalog from the Alexandria (VA) City Public Schools. Students will “find out how to use the IRS to fund college through ‘tax scholarship’. This seminar will give you the tools and knowledge to meet your goals.’”

That’s right: If your goals include maximizing the amount that other people have to pay for you or yours to go to college, Alexandria has a fantastic deal for you! And don’t worry, only saints refrain from stealing these days, and who wants to be one of them?



Obama’s Not-So-Centrist Cabinet

Journalists continue to insist that President-elect Obama has named a largely centrist Cabinet. But they’re clinging to a storyline that might have been true two weeks ago but no longer is. Obama’s national security team — Hillary Clinton, Robert Gates, and James L. Jones — and his economic team — Lawrence Summers, Tim Geithner, Christina Romer, and Bill Richardson — could be regarded as centrists, or at least as centrist Democrats.

But as the Cabinet selection process went on, Obama increasingly named left-wing activists to jobs in which they could carry out his ambitious plans to “transform our economy” and be the 21st-century Franklin Roosevelt. Tom Daschle at HHS wrote a book on how we need a Federal Health Board to manage and regulate every aspect of our health care. Hilda Solis at Labor is a sponsor of the bill to eliminate secret ballots in union authorization elections and of heavy regulatory burdens on business. She opposed the Central America Free Trade Agreement and generally opposes free trade. Shaun Donovan worked on affordable housing issues in the Department of Housing and Urban Development during the Clinton administration — just the policies that led to the mortgage crisis and then the general financial crisis. His reward for a job well done? He’s coming back as secretary of HUD.

White House science adviser John Holdren is an old-time “running-out-of-resources” Paul Ehrlich cohort who disdains economics and famously lost a bet with Julian Simon on whether the prices of natural resources would rise, reflecting growing scarcity. He and Steven Chu as Secretary of Energy; former New Jersey Department of Environmental Protection chief Lisa Jackson as the head of the Environmental Protection Agency; and Carol Browner, former administrator of the Environmental Protection Agency under President Bill Clinton, as the White House’s “energy/climate czar,” are all global-warming catastrophists who see an urgent need to impose crushing burdens on the economy in the name of influencing the climate a century from now.

The choice of Tom Vilsack to be secretary of agriculture is said by the Washington Post to be an example of Obama’s moderation and intention to balance competing interests. You see, he’s popular with “groups representing big agricultural interests, which praise him for his support of biotechnology and subsidies for corn-based ethanol.” But also with groups that want to shift Ag dollars to smaller farms. So the question to be decided is who gets the gravy, not whether the gravy will be ladled out by Washington. There doesn’t appear to be anyone in the Obama Cabinet who will speak for the taxpayers’ interest. Or who will argue that it would best for the whole country to let the market work and not have the government pick any winners or losers.

Sometimes journalists just don’t seem to reconcile the “centrist” claim with their own understanding of Obama’s intentions. The Los Angeles Times, for instance, begins its article, “The Cabinet that President-elect Barack Obama completed on Friday is a largely centrist and pragmatic collection of politicians and technocrats without a pronounced ideological bent.” But two paragraphs later the authors note:

Obama wants this Cabinet to market and put in place the most dramatic policy changes in the country since Franklin D. Roosevelt’s New Deal: a mammoth program to improve roads and bridges; a healthcare system that covers more sick people at less cost; limitations on fossil fuels and greenhouse gases that contribute to global warming; big investments in energy efficiency; middle-class tax cuts along with a tax hike on wealthy Americans.

That doesn’t sound like the agenda for a pragmatic and non-ideological administration. That’s what you would expect from a bunch of statist ideologues who have been waiting years or decades for an election and a crisis that would allow them to fasten on American society their own plan for how energy, transportation, health care, education, and the economy should work. That’s not centrist, it’s a collectivist vision hammered out by Ivy Leaguers and activists over the past couple of decades. In its more idealistic formulation, it’s based on the premise that smart people know what the people need better than the people themselves do, and that command and control work better than markets and individual choice. In its more practical application, it’s interest-group rent-seeking dressed in the trappings of public interest.

The proof will be in the pudding, of course. It’s the policies that matter, not the people. But these are people who weren’t selected for the misty dream of listening “not to your doubts or your fears but to your greatest hopes and highest aspirations” but rather for their determination to ensure that “generations from now, we will be able to look back and tell our children that this was the moment when we began to provide care for the sick and good jobs to the jobless; this was the moment when the rise of the oceans began to slow and our planet began to heal; this was the moment … when we came together to remake this great nation.” And for their commitment to use “this painful crisis [as] an opportunity to transform our economy.”

And for the rest of us, this is a time to remember that limited constitutional government and free markets sustain life, liberty, and the pursuit of happiness better than collectivist agendas carried out by powerful states.

More Power to State

The New York Times reports on Hillary Clinton’s efforts to reassert the State Department’s power over US foreign policy. This is, in one sense, good news. A bloated budget and far flung combatant commanders have allowed the Pentagon to trample over Foggy Bottom in recent years. That is bad not because diplomats are inherently wiser than generals, but because the competition of relatively balanced bureaucratic powers is generally conducive to wise policy.

The trouble here is the idea, hinted at in the Times story, that increased State Department capacity will bring success in state-building missions. A peculiar hubris of Democratic foreign policy analysts is their confidence that they have discovered a science of nation-building by watching the Bush Administration screw up. They see errors on the road to chaos during the occupation of Iraq and assume causality.  They read a little about counter-insurgency and the Small Wars Journal blog. Avoid the errors, apply the best practices, and you are gold, they say. So: more troops, better plans, more interagency coordination, more reconstruction, and so on – and, presto, you can “fix” failed states that you occupy, like Afghanistan, or even states you don’t occupy, like Pakistan.

As I wrote here and said last week, this would-be science provides leaders with confidence they should not have to undertake dumb wars or to establish excessive goals for sensible wars. Hopefully, I will be proved wrong in Afghanistan, where we are about to test this kind of thinking.